Key Concepts

Please find below definitions of the key concepts with regards to health inequalities and health promotion.

Health equity (and equity in health)

Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically (WHO, 2009a). “Health equity” or “equity in health” implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential (WHO, 2009b). Therefore, health equity is the absence of health inequalities (applying the aforementioned definition). (Spanish Presidency Report 2010)

Health inequalities (and inequalities in health)

Taken literally, the term "health inequalities" means differences in health status between individuals or groups, as measured by, for example, life expectancy, mortality or disease. What we are interested in are differences in health that arise not from chance or from the decision of the individual but from avoidable differences in social, economic and environmental variables (e.g. living and working conditions, education, occupation, income, access to quality health care, disease prevention and health promotion services) that are largely beyond individual control and that can be addressed by public policy. Therefore, health inequalities here refer to avoidable and unfair differences in health that are strongly influenced by the actions of governments, stakeholders and communities, and that can be addressed by public policy (European Commission, 2009).

Social determinants of health

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices (WHO, 2009c).

Social exclusion

Exclusion consists of dynamic, multidimensional processes driven by unequal power relationships interacting across four main dimensions (economic, political, social and cultural) and at different levels including individual, household, group, community, country and global levels. It results in a continuum of inclusion/exclusion characterised by unequal access to resources, capabilities and rights which leads to health inequalities (SEKN, 2008). Social exclusion distances people from employment, income and education and training opportunities, as well as from social and community networks and activities. Socially excluded persons have little access to power and decision-making bodies and thus often feel powerless and unable to take control over the decisions that affect their day-to-day lives (European Commission, 2004).

Social gradient in health

The term social gradient in health refers to the stepwise or linear decrease in health that comes with decreasing social position (Marmot, 2004). The impact of the social gradient is sometimes expressed as a shortfall in health, that is, the number of lives that would have been saved if all groups in society had the same high level of health as the most advantaged group (Whitehead M, Dahlgren G, 2006).

Vulnerable groups (or socially disadvantaged groups)

Vulnerable groups suffer a markedly greater burden of mortality and disease. They may include socially excluded migrant groups and ethnic minorities, people living in deprived urban and rural areas and in poverty, the long-term unemployed, those informally employed, seasonal/daily workers and subsistence farmers, those further from the labour market, jobless households, the homeless, the disabled, those suffering from mental or chronic illnesses, elderly pensioners on minimum pensions, and single parents). For example, the Roma can expect to live 10 years less than the majority population in some countries (European Commission, 2009).